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_ SAN—'�')AQUIN.00UNTYFUBL1C HEALTH "PRVICES pa7jl ' <br /> �ENVIRCNMENTAL HEALTH DTVI N <br /> 304 EAST WIEDER AVENUE,THIRD FLOOR <br /> -STOCKTON CA 95202 <br /> J U L 1 1 ? s J l (209) 468-3420 <br /> - ,'PUBL.IC RECORDS RELEASE APPLICATION <br /> APP&ANT�._.._ itL�].'' Leg, BUSINLSWAGENCY. n«f <br /> ADDRESS 4 �. -- <br /> ptioNE FACSIMILE r <br /> TENTATIVE"APPOINTI4 EW DATE TIME <br /> (F1 lease give 7 to I 3susinais*ilaxs from data of application 3ubrsittal) <br /> CHECK BOX TO EXPEDITE REQUEST'-$7 d FES— <br /> EST D IN 3 t3LISINES5 pAYS <br /> SIGNATURE OF AFPL•ICANT CATS a•� '� <br /> FILIn ADDRESS <br /> � 35a <br /> 7sa�r <br /> v LS <br /> 3s.a7 w . <br /> �ILW v 35--XV >a <br /> ENVIRONMENTAL HF-ALT"DIVISION FILI=S <br /> UNDERGROUND TANK(LIST)CLEANUP SITE(LOP) CI HOUSING ABATEMENT GI SOLID WASTE FACILITY <br /> OTHER CLEANUP 51TE(NON-LOP) CI FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNbERGFtOUND TANK(MONITOR NGIREMOVAL) 0 DOG KENNEL EI DAIRY <br /> HAZARDOUS WASTE(5F_NERAT0R CI CNIcKEN RANCH CI PKG TREATMENT PLANT <br /> ❑ TiF;RED PERMITTED FACILITY ❑ MOTELIHOTEL Q PUMPER TRUCKIYARDJCHEMTOILETS <br /> ❑ TATTOOIBODY PEiRCING '. d POO[ISPA 0 LANA USE APPLICATION SrITS <br /> ❑ MF-DiCAL WASTE FACILJTY ❑ PUUUC WATER SYSTE W ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> A. List up to ten addresses in the spats above. Select the type(s)of files from the list above by checking <br /> the appropriate bares). At least one file type MUST be selected. Fpx to (7-09)464-0138 or mail to the <br /> AQclres indjcateo aboo <br /> Z. EHD will notify;the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately'fivo business days but no later than ten(10) days after receipt of applicatiom The files <br /> will be held fora maximum of rive business days for review. Appointments should be scheduled <br /> accordingly, <br /> 3. A file that is actively being worked on by I HO staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at ht?� the expense <br /> da <br /> of tappiicarit. >=uture�file reviews by the same applicant may require a$'78.00 push print to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with END staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> s <br /> CCNF)RMI-D APPOINtMENT BATE _ _ _ TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED `LE5 NO REVIEW DATE; <br /> Bf tltl it tlilGSA]U , <br /> 5 <br />